2024 American Society of Clinical Oncology Genitourinary (ASCO-GU) Cancers Symposium

Society of Clinical OncologyGenitourinary Cancers (ASCO-GU) Symposium.This highly anticipated event drew together specialists in GU cancer from diverse corners of the world.With a focal point on cutting-edge science, interdisciplinary expertise, and evidence-based practices, this year's symposium became a nexus for advancing knowledge in the realms of GU cancer treatment, research, and patient care.Following this symposium, on January 31, the Canadian Urological Association (CUA) convened an online webinar where Canadian experts highlighted pivotal research findings in bladder, kidney, and prostate cancers.In the subsequent sections, we distill the essence of the latest breakthroughs unveiled at ASCO-GU 2024.The entire webinar is available for viewing on UROpedia Canada, and meeting abstracts can be accessed through the ASCO meeting library. KIDNEY CANCERDr. Jeffrey Graham provided a comprehensive overview of recent adjuvant and metastatic renal cell carcinoma (RCC) trial developments.In the adjuvant space, CheckMate 914, a phase 3, randomized, double-blind trial, investigated adjuvant nivolumab vs. placebo for localized RCC in patients at high risk of relapse postnephrectomy.The study comprised two distinct parts: Part A examined adjuvant nivolumab plus ipilimumab vs. placebo, while Part B focused on nivolumab monotherapy vs. placebo.Disappointingly, results from Part A, evaluating six months of adjuvant nivolumab plus ipilimumab vs. placebo, yielded negative outcomes for the primary endpoint of disease-free survival (DFS). 1 Similarly, results from Part B showed no discernible difference in 18-month DFS between the groups (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.62-1.21,p=0.396). 2 Subgroup analysis revealed no overall benefit of adjuvant nivolumab, although potential value emerged in sarcomatoid-differentiated patients and those positive for PD-L1.In terms of toxicity, the nivolumab plus ipilimumab combination resulted in higher rates of immune-mediated toxicity, where 19% of patients in the combination arm needed high dose of steroids to manage immune-mediated adverse events (AE) compared to 6% and 2% with nivolumab and placebo, respectively.Results from the phase 3 KEYNOTE-564 study, assessing adjuvant pembrolizumab vs. placebo in clear-cell renal cell carcinoma (ccRCC), unveiled promising overall survival (OS) outcomes. 3Building on prior evidence of improved DFS post-nephrectomy, adjuvant pembrolizumab demonstrated a notable 5% absolute improvement in survival at 48 months, marking a significant milestone as the first adjuvant trial in kidney cancer to show OS benefit. 3,4The one-year treatment with pembrolizumab led to an improvement in OS (HR 0.62, 95% CI 0.44-0.87,p=0.002) in high-risk ccRCC patients compared to placebo.Encouragingly, this OS benefit extended across clinical subgroups, including patients with M0 disease, M1 NED, PD-L1 CPS <1 or CPS ≥1, and those with sarcomatoid features.This is the first adjuvant therapy to demonstrate an improvement in OS in high-risk RCC.Updated DFS data continued to demonstrate a benefit with pembrolizumab compared to placebo at the 48-month followup.Noteworthy is the absence of new safety concerns, although it is crucial to highlight that 9.4% of pembrolizumab-treated patients experienced grade 3-4 AEs, and 7.6% required high-dose steroids.This information is paramount for patient counselling on adjuvant treatment.